• Clefts of the Lip require operation to give the child a normal look.
• To understand the role of operations in Clefts of the palate, we should understand the function of the palate.

The palate is made of two parts, viz. the hard front part and a soft curtain like back part. When we speak, the soft curtain like part moves upwards and touches the back wall of the throat and closes the communication between oral and nasal cavity. The soft palate thus prevents leakage of the air during speech. This is the most important mechanism in producing clear , easily understandable speech. In cleft patients the soft palate function is not there. As a result the re is a leakage of air during speech producing nasal voice Similarly while eating, the soft palate prevents leakage of food through the nose by closing the curtain between oral and nasal cavities. Absence of the soft palate causes food regurgitation from the nose. Thus, it is very essential to repair this cleft and provide an effective barrier between oral and nasal cavity .

• We should also understand the role of clefts in hearing. The hearing is dependent on many factors. One of them is an intact system of tiny bones located in the middle ear cavity inside the bony skull. This cavity has a direct communication through a tube known in medical terms as Eustachian tube, with the upper part of the throat. This tube helps to drain the middle ear cavity. In the absence of a normal functioning cleft palate, the cavity is not properly drained. If there is any infection in the middle ear cavity, it may damage the tiny bones. This affects hearing and since the child speaks well only if he hears well, the development of speech is affected.
• Alveolus is the medical terminology of the teeth bearing part of the jaws. Many patients are having cleft that affects the alveolus also. It is necessary to repair the cleft of the alveolus so that the child develops normal teeth.
• Even the simplest cleft can have some deformity of the nose. This is corrected to variable extent when the lip is repaired.

Thus there are several factors which necessitate the operations. How many operations does a child need, can be discussed only after the child is seen by the plastic surgeon. As a general rule, a child may require some or all of the operations mentioned bellow at some stage in his life.

1. Lip repair

2. Palate repair

3. Operation for improving the speech

4. Operation for the cleft of the alveolus

5. Operation for improving drainage of the middle ear cavity

6. Operation to improve the nose and the facial profile

Plastic surgeons follow different time tables for doing all these surgeries. This we shall discuss as we describe the operations.

Before doing the operation, It is very important to know that a child should

• have weight proportionate to the age.
• have good hemoglobin percentage
• NOT have cold, cough, diarrhea or other diseases

Operations are not done if the child does not fulfill these requirements. Hence, it is very important to take care of feeding and the general health of the child. It is also important that the child is vaccinated as per schedule. Any delay in the operations can disturb the whole time table, and one may not yield the desired result.